Provider Demographics
NPI:1205280484
Name:VILELLA, LYMARIE M (ARNP)
Entity type:Individual
Prefix:
First Name:LYMARIE
Middle Name:M
Last Name:VILELLA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 PRAIRIE FALCON DR
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8005
Mailing Address - Country:US
Mailing Address - Phone:787-409-3993
Mailing Address - Fax:
Practice Address - Street 1:128 PRAIRIE FALCON DR
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-8005
Practice Address - Country:US
Practice Address - Phone:787-409-3993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-14
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11014131363LP0808X
FLF06212723363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health